Академический Документы
Профессиональный Документы
Культура Документы
Silliman University
WORLD VIEWS 2
profession through exploration of the various paradigm shift in different periods from the period
of intuitive nursing to contemporary nursing and will largely utilize Thomas S. Khun’s book
entitled “The Structure of Scientific Revolution in the synthesis of the subject matter. The book
explores the psychology of beliefs that govern the acceptance of new innovation in science.
According to Khun, science is not a one linear, rational progress moving toward ever more
accurate knowledge of an objective reality rather it’s one of the radical shift of vision in which a
From the view of Kuhn, paradigm in the natural sciences represents a series of simulated
tests and experiments that direct different types of questions relating to a particular topic and
makes answering to those questions purposeful. In fact, according to Kuhn’s opinion, paradigm
in the natural sciences shows how to conduct an experiment and the necessary equipment for
them. Also, Nursing is used in Kuhn’s definition of paradigm in defining the paradigm of nursing
Nursing paradigm governs the goals and boundaries like a foundation of a building. How
we think and give reason for human experiences can help in making the paradigm. Theories of
Nursing directs the creation of knowledge, methods and problem-solving activities with mutual
agreement of the epithetic community and by the help from certain discipline. In nursing, the
paradigm is based on sharing the values and presuppositions of key concepts, such as person,
The evolution of nursing started around early 1860’s which is also called as the Period of
Intuitive Nursing or Medieval Period. During this time, nursing was untaught and instinctive. It
was performed of compassion for others or out of the wish to help others.
Nursing was a function that belonged to women. It was viewed as a natural nurturing job
for women because she is expected to take good care of the children., sick and the aged. During
this time there was no caregiving training was evident. It was only based on experience and
observation. Moreover, primitive men believe that illness was caused by the invasion of the
victim’s body of evil spirits. It was believed that the medicine man, shaman, or witch doctor had
the power to heal by using white magic, hypnosis, charms, dances, incantations, massage, fire,
Intuition means having the ability to know or understand things without any proof or
evidence. While observation means the act of paying close attention to something or someone in
order to get information. Therefore, nursing during was based on or agreeing of what is known or
understood without any proof or evidence and people agreed to what seems to be right without
any empirical evidence. This is due to lack of nursing theoretical framework to guide nursing
practice to a narrow understanding of nursing clinical mandate. This limited vision of nursing
practice has been reflected by the value placed on patient outcome at the expense of careful
In Khun’s book this is the time of the emergence of normal science which is largely
based on one or more past scientific achievements on a specific field that some particular
scientific community acknowledges for a specific period of time as supplying the foundation of
During this period care was done by crusaders, prisoners and religious orders. Nursing
care was performed without any formal education by more experienced nursing (on the job
training). This kind of nursing was developed by the religious orders. At this point, nursing went
down to the lowest level. There was shortage of people to care for the sick, hundreds of hospitals
were closed, and there was no provision and no one to care for the sick. Nursing became the
Due to the existing crisis Pastor Theodore Fliedner and his wife decided to established
the first formal training school for nurses called “Keiserswerth Institute” for the training of
Deaconesses in Germany. This is where Florence Nightingale revives her 3-month course of
student nursing.
The development of nursing on this period was strongly influence from wars such as the
Crimean War or the Civil War, arousal of social consciousness and increased educational
opportunities offered to women. On 1853, the Crimean War begun and Florence Nightingale
together with 38 nurses were sent to Turkey to assist in caring of the injured soldiers. Nightingle
observed during service that there was under staffing, insufficient supplies and medical and
sanitary conditions where awful. Thus, impelled Nightingale to work on the improvement in the
environmental condition lead to the crafting of her book “Notes to Nursing: What it is and What
is not” which noted the need for preventive medicine and good nursing. The book has been the
basis in revolutionizing the nursing profession. This upgraded the practice of nursing and made
nursing an honorable profession for women. Furthermore, this period marks a big milestone on
WORLD VIEWS 5
the shift of nursing from simple observation and intuition to making nursing a profession and a
discipline.
Nightingale promoted the importance of nursing and women’s role during the time of
poverty. According to Pearson and Vaughan (1986), Nightingale’s role closely attached nursing
to medicine. This attachment became a downfall of the Nightingale Era wherein nurses where
merely trained to observe patient condition and report changes to the doctor. This elevated the
From the current feminist perspective, Nightingale’s adherence to the medical model and
following the doctor’s order placed nurses (women) into handmaiden role, a position often
accepted by them in the past and with the advent of feminism. Looking at a different perspective,
dominated 19th century setting by exerting political influence at that time when women were
Feminist theory states the knowledge given the highest status today (scientific
knowledge) is in fact created by and for male interest and it has been considered as the only
legitimate knowledge because men has the power to do so as evidence in khun’s book the
structure of scientific revolution where in most scientific revolutions and true science are made
by men.
dominated by females is also capable in developing their own body of knowledge Hagelle (1989)
defines nursing knowledge is based in part on their situation as women in a patriarchal society
According to Harding (1986) feminist critique of science has helped us understand the
economic, political and psychological mechanism that keep science sexist and that must be
eliminated if the nature, uses and validation of knowledge seeking are to become humanly
inclusive ones.
Over time, theories have changed significantly, with parallel changes in society,
and this appears manifest in all contemporary theoretical constructions. In Nightingale’s case, the
environment of war was a primary factor in her theoretical construction; similarly, at the other
end of the nursing spectrum, space travel, significant in Rogers’ (1986) visionary view of
aerospace nursing, where during the 1980s, the advent of the space shuttle program brought the
idea/theories of living in outer space, closer to a supposed reality for everyday people. Nursing
theories constructed during the 1950’s and 1960’s outline widespread acceptance of specific
paradigmatic origins, perhaps indicative of the acceptance at that time which viewed nursing as a
Peplau’s (1952) theory (Marriner-Tomey 1989) is part of the second order change in
nursing, where patient needs were more the focus of her theoretical assertions and helped move
nursing toward a more non-positivist philosophy and stands in stark contrast to the medical
suggest a move away from disease processes, to the meanings of events, feelings and behaviours.
Other theorists such as Neuman (1989, 1982) and King (1971) both use a systems theory platform,
with King’s theoretical assertions, maintaining a collection of statistical data as its main scientific
foundation; both appear to endorse nursing as fulfilling a deliberate action along positivistic lines,
but, start to show the beginnings of a more humanistic base. Neuman (1982 p.1) reinforces this
WORLD VIEWS 7
point declaring we should ‘... refuse to deal with single components, but instead relate to the
concept of wholeness’. Neuman’s reliance on a systems theory had changed significantly, showing
her movement from one paradigm to another, as she developed and refined her theoretical position
in 1989.
Interestingly, many nursing theorists changed their orientations over the years in respect to
their theoretical assertions. Neuman (1989, 1982), and King (1981, 1971) originally both working
within a systems theory and gradually assuming more of an interpersonal theoretical position.
Although Orem’s (1971) work has a needs orientation, it could also be tied to both an interaction
and systems theoretical base. The author is not sure if this was the theorist’s initial intent or whether
construction of nursing moves toward changing the focus of nursing, by endeavouring to humanise
both nurse and patient (Holmes 1990) and, with Rogers (1970), moved the process of theoretical
construction in nursing toward a more humanistic, non-positivist standpoint. These points are
exemplified by Rogers (1970) considering man as a unified whole and moved her original theory
toward a more humanistic model which were then influential in Parse (1981), who grounded her
PARADIGMATIC SHIFT
As nursing began to adopt a more humanistic science, for which methodologies had been
devised to supplement, enhance and transcend positivist approaches in the search for
understanding (Rogers 1970), perhaps nurses and nursing has become more accepting of a
WORLD VIEWS 8
(1986, 1979), Benner (1984) and Watson (1985, 1979) who endorse non-positivist philosophies,
This era is the time of development of cognitive skills and research methodologies and
the emergence of the plethora of nursing paradigms. The positivist perspective by Khun is
inappropriate and too narrow for a human science such as nursing that confronts a variety of
Development of a Research base practice. Research gradations from the empirical and
interpretative paradigms are complementary as each represent a different approach (Poole and
Jones, 1996). Integration of quantitative and qualitative method have been suggested to advance
nursing science.
V. Future
This change moves away from all-inclusive to a more post-modern theorization. This development
has moved from a position which promoted nursing as a science, reliant upon observation and
adherence to the medical model and specific patient needs as the goal of nursing, to a position
where a more holistic/humanistic focus became the currency of practice. Movement through this
period shifted the theoretical construction of nursing to interpersonal relationships, where nurse-
patient interactions were viewed as being clinically more significant than in the past. Systems
theories were introduced, although it is difficult to make clear distinctions between the
philosophies that distinguish systems theory from interpersonal relationships, with many
contemporary authors defining these fields differently. For example, the work of Rogers (1970) is
WORLD VIEWS 9
classified as systems theory in Torres (1986), energy fields in Marriner-Tomey (1989) and
outcome theory by Meleis (1985). This diversity of opinion is not helpful and demonstrates a lack
of clarity in the original theories and is a topic of much debate in nursing curricula. Clearly, we
need a combination of theories/models which incorporate the complexity and diversity of nursing
Many of the theories today appear somewhat dated and esoteric. I have argued here for
nursing to move toward a multiple model, capturing the philosophies of both positivist and non-
positivist paradigms (in a triangulated/overlapping way). This multiple model embraces evidence
based practice where we read all of the incoming patient data in devising diagnosis and developing
treatment strategies. Evidence based practice at the moment appears to be focused on the primacy
of the randomised clinical trial as the only legitimate source of evidence. According to Fawcett et
al (2001) most discussions of evidence based practice treat evidence as a theoretical entity which
tends to widen rather than close the theory practice gap. Pearson (1987) articulates this thought
saying we need to peruse multiple options and to value them all, in this way we could perceive
practical theory as legitimate theory; practice as theoretical; practitioners as theorists; and at the
same time acknowledge those scholars whose expertise lies in developing theory from outside the
practice world.
and begin to combine these changed philosophies with management initiatives such as case-mix
and diagnostic related groups that we do not go full circle and begin to embrace nursing care
driven by bureaucracy and fiscal policy. If we do this, it will be like returning to our ‘nursing
shift with Nightingale’ where we once again practice and rely on observable entities, with
demonstrated regularities and general laws verified through their measurement and
WORLD VIEWS 10
quantification, embracing the medical model; self-fulfilling the handmaiden role and
Quality of life theories More focus on Qualitative Research rather than Quantitative
Research. The shift from empiricism to interpretative. The creation of nursing philosophy as
an independent science
In the future, there is systems improvement. Paradigms are more focus on the delivery of
Nurses now lead, teach, capable of creating new knowledge and change the world and
works in collaboration with other discipline like medical robotics to further improve the practice
of nursing.
REFERENCES
Benner, P. (1984) From novice to expert: excellence and power in clinical nursing practice.
Benner, P. and Wrubel, (1989) The primacy of caring: stress and coping in health and illness,
1(1):13-23.
Chinn, P. and Kramer, M. (1991) Theory and nursing: A systematic approach, (3rd edn.) Mosby
Cody, W.K. (2003) Nursing Theory as a Guide to Practice, Nursing Science Quarterly, Vol. 16,
No. 3, 225-231.
WORLD VIEWS 11
Dreyfus, H. (1979) What computers can’t do: The limits of artificial intelligence (2nd edn.) Harper
Fawcett, J., Watson, J., Neuman, B., Walker, PH., & Fitzpatrick, J. (2001) On Nursing Theories
Habermas, J. (1981a) The Theory of Communicative Action, Vol 1, Trans. Mc Carthy, T. Beacon
Press, Boston.
Habermas, J. (1981b) The Theory of Communicative Action, Vol 2, Trans. Mc Carthy, T. Beacon
Press, Boston.
Holmes, C. (1990) Alternative to Natural Science Foundations for Nursing, International Journal
Im, E. & Chang, S (2012) Current trends in Nursing Theories, Journal of Nursing Scholarship.
44(2):156-64
King, I. (1971) Towards a theory of nursing. John Wiley and Sons, New York.
King, I. (1981) A theory of nursing: systems, concepts and process. John Wiley and Sons, New
York.
Marriner-Tomey, A. (1989) Nursing theorists and their work. (2nd. edn) C.V.Mosby,
WORLD VIEWS 12
St. Louis.
Martin, M. (2000) Verstehen: the uses of understanding in social science, Transaction Publishers,
New Brunswick.
Meleis, A. (2007) Theoretical nursing: development and progress, (4th edn) Lippincott Williams
Meleis, A. (2012) Theoretical nursing: development and progress, (5th edn) Lippincott Williams
Newman, M. (1986) Health as expanding consciousness, The C.V.Mosby Company, St. Louis.
Nightingale, F. (1969) Notes on nursing: What it is, and what it is not. Dover, New York.
Neuman, B. (1989) The Neuman systems model: Applications to nursing education and practice.
Nolan, M., Lundh, U. and Tishelman, C. (1998) Nursing’s knowledge base: does it have to be
Parse, R. (1981) Man-living-health: A theory of nursing, John Wiley and Sons, New York.
WORLD VIEWS 13
Pearson, A. and Vaughan, S. (1986) Nursing models for practice, Heinemann, London.
Pearson, A. (1987) Theorising nursing: The need for multiple horizons. Keynote Address
presented at the 3rd. National Nursing Education Conference, Perth, Dec. 4-9th.
Peplau, H. (1952) Interpersonal Relations in Nursing, G Putman’s and Sons, New York,. Polanyi,
M. (1969) Knowing and being, Routledge and Kegan Paul Ltd., London.
Ray, M. (1989) The Theory of Bureaucratic Caring for Nursing Practice in the Organizational
Reed, P. Shearer, N. and Nicoll, L. (2004) Perspectives on Nursing Theory (4th edn), Lippincott
Rogers, M. (1970) An introduction to the theoretical basis of nursing, F.A. Davis, Philadelphia.
Rogers, M. (1986) Dimensions of health: A view from space. Paper presented at the conference
on Law and Life in space. Sept. 12th. 1986. Centre for Aerospace Sciences, University of Nth.
Dakota.
Sarvimäki, A. (1988) Nursing care as a moral, practical, communicative and creative activity,
Connecticut.
Travelbee, J. (1971) Interpersonal aspects of nursing, (2nd. edn), F.A. Davis. Philadelphia.
Watson, J. (1979) The philosophy of science and caring. Little Brown, Boston.
WORLD VIEWS 14
Watson, J. (1985) Nursing: human science and human care, Appleton Century Crofts, East
Norwalk.